MEDICARE: DR. FERNANDO LEON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4749T	NV

General Provider Information

NPI Number	:	1093840712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FERNANDO LEON D.D.S.

Provider Business Mailing Address
First Line	:	2605 S DECATUR BLVD
Second Line	:	SUITE 116
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8591
Country	:	US
Telephone Number	:	702-876-2525
Fax Number	:	702-876-1686

Provider Business Practice Location Address
First Line	:	2605 S DECATUR BLVD
Second Line	:	SUITE 116
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8591
Country	:	US
Telephone Number	:	702-876-2525
Fax Number	:	702-876-1686

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	04/29/2009

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